All In the Family
My cousin, a radiologist in Canada, believes that as a physician, he shouldn’t be treating family members. As a dentist, though, I’ve always taken care of family. And even attempted working on the family dog. If nothing else, from my relatives’ point of view, free is free.
*****
I’ve kept one tooth over the years, tucked away with the inherited cocktail rings. It’s a molar, belonging to my father, with a half crown called a gold onlay. Like a bird with a broken wing, one of its three roots is fractured. The gold, though, looks brand new.
My parents’ holiday visit coincided with their semi-annual dental appointments. When Bill Clinton was president, I overhauled my dad’s mouth and now we were mostly on a maintenance routine. He wore a partial denture to replace some lost teeth, an appliance that he removed after
every meal to rinse off the trapped food debris. To solve this nuisance, I offered expensive implants, ones that for him would be a bargain.
“It’ll feel like real teeth,” I said. “And you don’t have to take them out at night. Or ever.”
“Not necessary,” he answered. That was my dad’s standard response to almost anything – hearing aids, cataract surgery, a haircut.
That November, as I was cleaning and examining his teeth, I noticed a small bump on the gum. “You have an infection.”
“What? I don’t feel anything,” he said.
On the screen, I pointed to a dark spot on his x-ray. “See, this can travel up to your brain and kill you.” The chances of him dying from a tooth infection were remote, but it has happened. Besides, I wanted to scare him.
Mostly to humor me, he consented to the extraction. Either that or he simply didn’t want to be badgered any further.
My father at 99. Now he’s 100.
Later in the palm of my hand, I showed him the tooth with its longitudinal crack running down the length of one root. “Oh, now I remember,” he said. “I heard a noise one day when I was eating chicken feet. I thought it’s a bone.”
I can’t remember if my father said thank you – and it’s not important. From that first crown where my husband volunteered to help me, I was now providing a service to my family, a thank you to my father for agreeing to board that cargo ship and move to the United States so many years ago.
His cracked tooth became my show-and-tell example, one I would produce to convince other asymptomatic patients with a similar problem. I kept it in a clear, sterilized bag in my desk drawer. More than one woman called it “touching” that I had saved my father’s tooth.
One person asked, “Don’t you want to get money for that gold?”
*****
The person I worked on the most was my mother-in-law. She was so easy in her transparency and self-sufficiency. The only part of her that wasn’t easy was her mouth. Like the ping of broken tennis racket strings, her teeth would break randomly, one by one until she had less than a handful left. Each time would entail repairing, redoing, adding another fake tooth to her dentures. Sometimes she spent weeks at our house, “dental wellness retreats,” she called them. After a long day of work, I never felt obligated to entertain her. She was happy watching action movies, swimming alone, or ordering Sammy the dog off the couch.
When my children were young, they would shriek in delight and horror at Grandma’s nearly toothless mouth and she would laugh along with them.
Enough teeth had broken that I proposed a more permanent, and radical, solution: we would take out her remaining teeth and make her false teeth anchored onto a bar and implants.
Right away she said, “Sure!”
She was an intrepid early adopter – instant messaging her grandchildren in garbled English, knowing next season’s colors, ziplining at the age of 80. Although I agonized over this decision, thinking she might be too old to undergo such a procedure, she appeared to have no qualms. Two titanium posts would be drilled into her jawbone. This technology, although not new, was not yet commonplace. Maybe she figured that anything would be an improvement - her lower denture floated like a toy duck in the bathtub.
My anxiety made up for her lack of it. Working with implants was like assembling Legos, or furniture, and I had done neither. Nor did I know what a torque driver was. The implant representative, George, and lab technician, Carlos, were on my speed dial. George sold me a one-inch special screwdriver and when I tried in the connecting bar, Carlos came to the office for moral support. I worried that I would drop one of the miniature screws into my mother-in-law, infecting some healthy air pocket in her lung, killing her. Remembering Mrs. Cord, our dental school patient, I stressed over the lower denture. Only now there would be no professor supervising.
It is a fallacy that…
dentists learn all we need to know during training. Quite the opposite. Dental school produces dentists who are minimally competent. As for the subjects we weren’t taught in school – lasers, implants, anything new – like most dentists, I learned it in courses at night and on weekends. Mostly it was on the job training, garnering pointers on the backs of already treated patients and previous failures. More than one continuing education speaker said, “Today I wouldn’t approach the case the same way.”
“Søren Kierkegaard said it best: “Life can only be understood backwards; but it must be lived forwards.”
Scary, right?
Back home after her case was completed, she messaged, “I can eat butts and seeks agin.” When I phoned for an explanation, she said, “Nuts, nuts and seeds. That’s what I wrote.”
Mrs. Cord also loved nuts but was resigned to her inability to eat cashews, unlike my mother-in-law who was crunching away. Despite the novelty of the procedure, we both entered into an equal partnership: She gave me permission to try and help her even if it meant failure; despite my inexperience, I fully believed this was the best way to help her even if it meant failure. There was such a beauty to this mutual understanding.
When she died, her children wanted her displayed at the memorial service in an open casket. I longed to ask if I could keep her dentures and the connecting bar, use it as an educational and marketing prop. But I didn’t dare ask, knowing she would be in full view. Without the support of her teeth, she would’ve looked like a shrunken old woman. I wanted everyone to remember her as the ziplining grandma.
But I think she would have gladly given them to me though, promptly saying “Sure!”
My mother-in-law at her 90th birthday celebration, ten years after her implants were done.